Toads-in-the-Hole

Many people have verbal habits: words or phrases that they routinely use without thinking of it. I had a colleague once who would frequently preface many otherwise perfectly straightforward utterances with the word “honestly”, as in, “Honestly, I’m incredibly pleased it’s payday.” Shortly before I left the job I teased my colleague about this habit, “When you don’t say ‘honestly,’ should I wonder if you’re lying?”

I find myself remembering a lot of these verbal tics, from my Scoutmaster who would finish a great many of his already difficult-to-follow instructionals on emergency first aid or wilderness survival with the unreassuring “…aaaand so on and so forth,” to the guy who lived down the hall from me in college who would end a large minority of his sentences with “’nshit” (“Hey, when I’m all done with my calculus ‘nshit, you wanna head to the caf for some dinner ‘nshit?”).

Many people fortify their speech with these old stand-bys as a kind of verbal shorthand. My Scoutmaster, for instance, had taught something like five thousand callow youths how to tie a bowline, which is the knot that if you could perform it one-handed, could be used to tie a length of rope around your waist which could then pull you out of a lake or a river or a deep hole into which you’d fallen and broken your arm and were otherwise unreachable except for with a length of rope. As I belonged to an accident-prone Scout Troop, this scenario did not seem at all wild.

Upon teaching perhaps his five hundredth callow youth, he’d probably become pretty good at teaching the one-handed bowline. Somewhere around three thousand, he most likely started cutting corners and, after getting through what he deemed to be the tricky part of the one-handed bowline, “aaaand so on and so forth,” would spill out of his mouth, and he would move on to the next ephebe with the kind of manly efficiency that is so striking in the middle-aged white male dressed in short green shorts and long red stockings. Of course, the greenhorn he had left behind would be left (if they were me) with a sad tangled length of rope and the difficult-to-shake notion that anyone attempting to rescue his busted-arm-self would run out of patience long before the bowline was successfully completed.

For those of you for whom she is the main attraction of this website, here's a gratuitous picture of Adelaide dressed as a sprout.

Thus does haste make waste, mode of speech-wise, and in no venue here in my third year of medical school is that more obvious than in the clinic. If my old Scoutmaster had taught five thousand young scouts the one-handed bowline, the clinicians I follow have seen, on average, fifty thousand patients in the office setting. Of course, no two patients are alike, and the clinicians I follow that see a wide variety of complicated cases (i.e. my Internist and Family Practice docs) seem to be free of verbal habits.

One attending, however, sees a great many of the same type of patient: the perfectly healthy pregnant woman. Perhaps as a form of self-defense, he has reduced the talking part of these office visits to the following three questions, always uttered with the same tone and inflection: 1) “Having any contractions?” 2) “Any bleeding?” 3) “Any questions?”

He occasionally embroiders upon this pattern, inquiring about fetal movement or nausea, but for most patients I can (and don’t) silently lip-sync the dialogue along with him. As a further shortcut, he refers to all of his patients (regardless of age) as “Kiddo.” Medical students (at least male ones) are referred to as “Dude.” Surprisingly- perhaps because he has sleepy eyes, a goofy grin, and a pleasant tone of voice- he is considered one of the friendlier doctors around.

Another attending of mine leans heavily on “You know what I mean?” to fill the space in between sentences. There may have been a time when he said this to make sure that the patient understood and to allow them an opportunity to ask questions. Now, however, like a fashion sense developed to be attractive in the 1980s, his phrase accomplishes the opposite of its original purpose, as he says it with so little curiosity and accompanied by such a surprisingly baleful glare (he is generally a very amiable guy) that patients find themselves simply nodding rapidly in response, as though a teacher had suddenly nailed them with the old “Have you been listening?”

When he appends his catch-phrase onto the description of a procedure or the possible complications of that procedure, I morbidly watch the patients’ affirmative nod suddenly change into a blank inwardness, and then sudden anxiety, as follows:
Doctor: “So we’ll make an incision a little below your costal margin, you know what I mean?” [The patient nods affirmatively, thinking, “Right. An incision, that’s like a cut. I’m totally picking up what he’s putting down.” The patient suddenly develops an inward look. “Wait, where’s my ‘costal margin’?”) “Now, possible complications of this can be infection, damage to your biliary tract, and bleeding, you know what I mean?” [The patient nods, they know all these words. Except for maybe ‘biliary tract’. The patient develops an inward look as they wonder what exactly the doctor means by “infection, bleeding, and damage.” Then they suddenly look anxious.] I have never heard a patient say, “No, wait. I don’t know what you mean. What happens if I bleed, get infected, and you damage my Bel Air Track?”

I am still learning how to be a doctor, but I have seen my own proclivities toward cutting verbal corners. Those of you who know me personally know of my ability to mutter. I have found that, unless I’m alert, I can make one of own routine phrases, “Have you had any changes with your urination?” sound like one medium-sized word. The patients I mutter this to, bless them, can always tell by my tone of voice that the right answer is, regardless of what I actually asked them: “No.”